Spine Journal最新文献

{"title":"Contemporary decision-making factors leading to cervical disc replacement versus fusion for the treatment of single-level degenerative cervical radiculopathy or myelopathy: survey opinions from members of the society of minimally invasive spine surgeon and cervical spine research society","authors":"Karim A. Shafi MD , Adrian T.H. Lui MBBS , Christopher Mikhail MD , Kyle Morse MD , Joshua Zhang BS , Cole Kwas BS , Hyun Bae MD , Sravisht Iyer MD, MPH , Sheeraz Qureshi MD, MBA","doi":"10.1016/j.spinee.2025.08.334","DOIUrl":"10.1016/j.spinee.2025.08.334","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Degenerative cervical radiculopathy and myelopathy are frequently encountered pathologies in spine surgery. Cervical disc replacement (CDR) offers a motion-preserving alternative to conventional anterior cervical discectomy and fusion (ACDF). Presently, there is limited consensus on which variables impact the decision to perform fusion versus arthroplasty for this disease.</div></div><div><h3>PURPOSE</h3><div>This study aims to characterize current practices for the treatment of single-level degenerative cervical radiculopathy or myelopathy and to identify and rank clinical and radiographic variables that most influence surgical decision making with regards to ACDF and arthroplasty.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Descriptive, cross-sectional survey.</div></div><div><h3>SUBJECT SAMPLE</h3><div>An 11-item survey was distributed to surgeon attendees of the Cervical Spine Research Society's (CSRS) 52nd Annual Meeting and members of Society for Minimally Invasive Spine Surgery (SMISS) in 2024.</div></div><div><h3>OUTCOME MEASURES</h3><div>Surgeons reported practice demographics, CDR training, attitude towards current literature, and adoption patterns. Surgeons were asked to rank 7 clinical factors and 8 radiographic parameters in order of importance when deciding between CDR versus ACDF.</div></div><div><h3>METHODS</h3><div>Primary analysis was performed to summarize demographic data, surgeon attitudes, and adoption. Descriptive and stratified analysis was performed to identify significant trends and associations among these factors. Clinical and radiographic parameters were ranked in order of importance and were compared. Rankings for each parameter were reported as means, highest and lowest rankings, and percentiles. Each parameter’s ranking frequency was then reported as most important, top 3 most important, and top 5 most important.</div></div><div><h3>RESULTS</h3><div>A total of 75 completed responses were received. Most respondents performed fewer than 25% CDR for primary cases, with only 4% reporting utilization rates of >75%. More private surgeons (50%) adopt CDR in >25% of their cases compared to academic surgeons (13%). CDR adoption varied significantly by region, with the Southwest (71%) and Southeast (57%) regions having the highest proportions of surgeons adopting >25% CDR in their practices as opposed to ACDF. The most cited barrier was risk-benefit trade-offs (28%). 87% of respondents viewed the current evidence for CDR as high quality, 11% rated it as low quality and unconvincing. Hypermobility/connective tissue disease and severe myelopathy were clinical deterrents for CDR. Segmental instability and significant kyphotic deformity were radiographic determinants for choosing ACDF over CDR.</div></div><div><h3>CONCLUSIONS</h3><div>There is limited evidence on the variables that most affect surgical decision-making when choosing between ACDF and CDR for degenerative cervical radicul","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 504-514"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to ‘Perioperative inpatient falls for anterior cervical discectomy and fusion patients are on the rise: risk factors associated with this “never event”’ by Anthony E. Seddio et al’ [The Spine Journal 25/5 (2025) 911-920]","authors":"Anthony E. Seddio MD, Sahir S. Jabbouri MD, Michael J. Gouzoulis MD, Rajiv S. Vasudevan MD, Scott J. Halperin MD, MHS, Arya G. Varthi MD, FAAOS, Daniel R. Rubio MD, FACS, FAAOS, Jonathan N. Grauer MD","doi":"10.1016/j.spinee.2025.11.005","DOIUrl":"10.1016/j.spinee.2025.11.005","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Page 643"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of posterior cervical spine surgery on neck pain-related driving disability and risk factor analysis of postoperative worsening or poor improvement: a retrospective multicenter cohort study","authors":"Naoki Okamoto MD ,&nbsp;Hideki Nakamoto MD, PhD ,&nbsp;Hiroki Iwai MD, PhD ,&nbsp;Naohiro Kawamura MD, PhD ,&nbsp;Akiro Higashikawa MD, PhD ,&nbsp;Nobuhiro Hara MD ,&nbsp;Yujiro Takeshita MD ,&nbsp;Masayoshi Fukushima MD ,&nbsp;Takashi Ono MD ,&nbsp;Masahito Oshina MD ,&nbsp;Shima Hirai MD ,&nbsp;Kazuhiro Masuda MD ,&nbsp;Shurei Sugita MD, PhD ,&nbsp;Sakae Tanaka MD, PhD ,&nbsp;Yasushi Oshima MD, PhD","doi":"10.1016/j.spinee.2025.10.025","DOIUrl":"10.1016/j.spinee.2025.10.025","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Previous research has shown the positive effect of 1- and 2-level anterior cervical spine surgery on driving disability; however, the impact of posterior cervical spine surgery, which is usually performed for 3 or more level pathologies, remains unexplored.</div></div><div><h3>PURPOSE</h3><div>To investigate the impact of posterior cervical spine surgery on neck pain-related driving disability and identify the risk factors for poor driving outcomes.</div></div><div><h3>STUDY DESIGN</h3><div>A retrospective review of a multicenter prospective database.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients undergoing posterior cervical spine surgery for degenerative cervical myelopathy.</div></div><div><h3>OUTCOME MEASURES</h3><div>Data were collected on patient and surgical characteristics and patient-reported outcome measurements (PROMs), including the Neck Disability Index (NDI), Numeric Rating Scale for neck/arm pain, EuroQol 5 Dimension, Japanese Orthopedic Association scores, and postoperative satisfaction.</div></div><div><h3>METHODS</h3><div>The NDI driving subscale (0–5) was used to evaluate neck pain-related driving disability at baseline and 24 months postoperatively. Driving severity was categorized as “non-to-mild” (score 0, 1, or 2) and “moderate-to-severe” (score 3, 4, or 5) and used to determine whether patients experienced postoperative improvement, worsening, or rest. Multivariate analysis was performed to identify clinical and surgical risk factors for deteriorating or persistent driving disability. We analyzed the association between driving outcomes and PROMs.</div></div><div><h3>RESULTS</h3><div>Of the 1,067 patients included, 277 (26.0%) reported moderate-to-severe driving disability at baseline. At 24 months, 70.8% of these patients experienced substantial improvement, whereas 29.2% did not. Among the 790 patients with baseline non-to-mild driving disability, 69 (8.7%) experienced significant postoperative deterioration. Multivariate analysis identified older age (odds ratio [OR] 2.6), female sex (OR 2.2), and ≥4-level fusion (OR 2.4) as significant risk factors for postoperative worsening, whereas older age (OR 2.1) was the significant risk factor for poor postoperative improvement. Patients with poor outcomes were less likely to achieve clinically significant improvements in all PROMs.</div></div><div><h3>CONCLUSIONS</h3><div>Posterior cervical spine surgery can improve driving disability associated with neck pain. Nevertheless, the potential risk of postoperative deterioration or poor improvement should be considered, particularly among patients who are older, female, or have undergone ≥4-level fusion surgery.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 536-547"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct postoperative quality of life trajectories after surgery for degenerative cervical myelopathy: a multicenter prospective cohort study","authors":"Takahiro Kitagawa MD, PhD ,&nbsp;Narihito Nagoshi MD, PhD ,&nbsp;Junichi Yamane MD, PhD ,&nbsp;Toshiki Okubo MD, PhD ,&nbsp;Yasuhiro Kamata MD, PhD ,&nbsp;Yosuke Horiuchi MD, PhD ,&nbsp;Norihiro Isogai MD, PhD ,&nbsp;Hitoshi Kono MD, PhD ,&nbsp;Reo Shibata MD, PhD. ,&nbsp;Yoshiomi Kobayashi MD, PhD ,&nbsp;Kanehiro Fujiyoshi MD, PhD ,&nbsp;Yoshiyuki Yato MD, PhD ,&nbsp;Takahito Iga MD, PhD ,&nbsp;Kazuki Takeda MD, PhD ,&nbsp;Masahiro Ozaki MD, PhD ,&nbsp;Satoshi Suzuki MD, PhD ,&nbsp;Morio Matsumoto MD, PhD ,&nbsp;Masaya Nakamura MD, PhD ,&nbsp;Kota Watanabe MD, PhD","doi":"10.1016/j.spinee.2025.10.023","DOIUrl":"10.1016/j.spinee.2025.10.023","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background Context&lt;/h3&gt;&lt;div&gt;Postoperative outcomes in degenerative cervical myelopathy (DCM) vary considerably, yet few studies have characterized the heterogeneous recovery trajectories using longitudinal data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To identify distinct postoperative quality of life (QOL) trajectories in DCM patients and determine baseline predictors of recovery patterns.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design/Setting&lt;/h3&gt;&lt;div&gt;Prospective multicenter observational study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient Sample&lt;/h3&gt;&lt;div&gt;A total of 977 patients undergoing surgery for DCM across 10 high-volume spine centers in Japan.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;div&gt;The QOL outcome measure comprised the Short Form-36 physical component summary (PCS) score. Functional outcomes were specifically captured through Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Outcomes were measured at baseline, 6, 12, and 24 months postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Latent growth mixture modeling was employed to classify patients into distinct postoperative recovery trajectories based on PCS trends. To identify independent predictors of trajectory membership, multinomial logistic regression was performed, with variable selection refined through least absolute shrinkage and selection operator regression (LASSO) regression. Model performance was assessed using area under the receiver operating characteristic curve (AUC) for discrimination and decile-based calibration plots with bootstrap validation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 4 distinct PCS recovery trajectories were identified: Low-to-High (L-H, 7.3%), High-to-High (H-H, 44.9%), Low-to-Low (L-L, 37.7%), and Initial-Decline (I-D, 10.1%). Preoperative lower extremity function emerged as the strongest predictor of trajectory class, reflecting the baseline QOL. Additional significant predictors included age, smoking history, symptom duration, and cervical spine function. Particularly, reduced cervical function at baseline was found to be a significant predictor of unfavorable QOL at 24 months. The prediction model demonstrated good discriminatory performance following least absolute shrinkage and selection operator (LASSO) regression for common classes (AUCs: H-H=0.86, L-L=0.80) and moderate performance for L-H class (AUC 0.74). However, accuracy was limited for the I-D class (AUC = 0.63), and calibration was compressed in rarer classes due to class imbalance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Distinct patterns of postoperative recovery exist among DCM patients, with baseline physical function and patient characteristics significantly influencing QOL trajectory. While predictive models reliably distinguished major recovery patterns, less frequent trajectories, particularly those involving deterioration, were difficult to forecast. These findings support the utility of trajectory modeling and patient-reported outcome measures to enhance ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 525-535"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior cervical discectomy and fusion provides better outcome compared to posterior cervical foraminotomy when foramen is vertically narrow","authors":"Sehan Park ,&nbsp;Dong-Ho Lee MD, PhD ,&nbsp;Chang Ju Hwang ,&nbsp;Jae Hwan Cho ,&nbsp;San Kim","doi":"10.1016/j.spinee.2025.10.015","DOIUrl":"10.1016/j.spinee.2025.10.015","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Posterior cervical foraminotomy (PCF) cannot widen the neural foramen vertically, whereas anterior cervical discectomy and fusion (ACDF) could increase foraminal height (FH) by distracting the disc space.</div></div><div><h3>PURPOSE</h3><div>To compare the clinical and radiographic outcomes between ACDF and PCF in patients with cervical radiculopathy and vertically narrow foramina (FH &lt;6 mm).</div></div><div><h3>STUDY DESIGN</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients who underwent single- or multilevel ACDF (<em>n</em>=44) or PCF (<em>n</em>=33) between 2015 and 2022 and had at least one neural foramen with FH &lt;6 mm were retrospectively analyzed.</div></div><div><h3>OUTCOME MEASURES</h3><div>Clinical outcomes included visual analog scale (VAS) scores for neck and arm pain and the Neck Disability Index, assessed preoperatively and at 3 months and 2 years postoperatively. Radiographic parameters included FH, C2–C7 sagittal vertical axis, and cervical range of motion. Revision surgery rates and causes were also evaluated.</div></div><div><h3>METHODS</h3><div>Between-group comparisons of continuous variables were conducted using Student’s <em>t</em> test, whereas categorical variables were analyzed using the chi-squared test. Paired <em>t</em> tests were used to compare repeated measures over time. Intraobserver reliability of radiographic measurements was assessed using intraclass correlation coefficients.</div></div><div><h3>RESULTS</h3><div>Preoperative demographics and clinical scores were comparable between the groups. Postoperative FH significantly increased only in the ACDF group (p&lt;.001) and was significantly greater than that in the PCF group at both 3 months and 2 years (p&lt;.001). Neck and arm pain VAS scores significantly worsened in the PCF group between 3 months and 2 years postoperatively (p=.003 and p=.003, respectively) but remained stable in the ACDF group. At 2 years, the VAS scores for neck and arm pain were significantly worse in the PCF group (p=.004 and p=.036, respectively). Although the overall revision rates did not significantly differ (ACDF 6.8% versus PCF 12.1%, p=.161), all PCF revisions were owing to recurrence of radiculopathy at the index level (p=.030), whereas ACDF revisions were unrelated to index-level pathology.</div></div><div><h3>CONCLUSIONS</h3><div>In patients with vertically narrow foramina (FH &lt;6 mm), ACDF provides superior long-term pain relief and better restoration of FH than PCF. In this subset of patients, PCF may be associated with an increased risk of symptomatic recurrence at the index level. FH should be considered when selecting a surgical approach for cervical radiculopathy.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 515-524"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health disorders in adolescent idiopathic scoliosis surgery: prevalence, postoperative outcomes, and opioid use","authors":"Maya S. Abu-Zahra BA ,&nbsp;William J. Karakash BS ,&nbsp;Natalie Kistler BS ,&nbsp;David McCavitt BA ,&nbsp;Henry Avetisian MS ,&nbsp;Daniel Rusu BS ,&nbsp;Aidan Lindgren BS ,&nbsp;Brandon Yoshida MD ,&nbsp;Jeffrey C. Wang MD ,&nbsp;R. Kiran Alluri MD ,&nbsp;Michael M. Safaee MD ,&nbsp;Raymond J. Hah MD","doi":"10.1016/j.spinee.2025.10.006","DOIUrl":"10.1016/j.spinee.2025.10.006","url":null,"abstract":"<div><h3>Background Context</h3><div>Adolescent idiopathic scoliosis (AIS) is a common spinal deformity often presenting during a critical period for psychological development. While AIS has been associated with increased rates of mental health disorders (MHDs), postoperative outcomes in patients with preoperative MHDs undergoing AIS surgery remain poorly understood.</div></div><div><h3>Purpose</h3><div>This study aimed to identify the perioperative prevalence of MHDs and evaluate the impact of preoperative MHDs on surgical outcomes and healthcare utilization in adolescents undergoing AIS correction.</div></div><div><h3>Study Design</h3><div>Retrospective database study.</div></div><div><h3>Patient Sample</h3><div>Patients aged 10-18 undergoing &gt;7-level posterior spinal fusion for AIS between 2010 and 2023.</div></div><div><h3>Outcome Measures</h3><div>Epidemiologic measures: MHD prevalence pre- and postoperatively, hospital readmissions, surgical and medical complications, revision surgeries, postoperative opioid use, and healthcare utilization costs.</div></div><div><h3>Methods</h3><div>Our population of interest was identified in the PearlDiver national database. Patients were stratified by presence of MHDs within 1 year perioperatively, defined using DSM-5 categories. Outcomes included MHD prevalence pre- and postoperatively, hospital readmissions, surgical and medical complications, revision surgeries, postoperative opioid use, and healthcare utilization costs. Pre- and postoperative rates of MHDs were compared using McNemar’s test. Propensity score matching (3:1) was performed based on age, sex, and Elixhauser Comorbidity Index (ECI), followed by univariate analyses.</div></div><div><h3>Results</h3><div>Among 11,624 patients, 15.92% had a documented preoperative MHD. MHD prevalence rose in the year prior to surgery and remained stable within 1 year postoperatively. After matching, patients with MHDs had higher total opioid use, increased opioid use between 90 and 180 days postoperatively, and higher healthcare costs at 90 and 365 days. No significant differences were observed in complication, readmission, or revision surgery rates.</div></div><div><h3>Conclusion</h3><div>In our cohort, 15.92% of AIS patients were diagnosed with an MHD within 1 year preoperatively, a prevalence that remained stable postoperatively. While AIS surgery is safe in patients with preoperative MHDs, these individuals experience higher total opioid use and greater healthcare utilization. Future research should aim to identify specific drivers of healthcare utilization in patients with MHDs and evaluate the impact of targeted mental health interventions on both psychological well-being and physical recovery to optimize outcomes for AIS patients.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 594-601"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative function of lower extremity muscles and walking ability after total en bloc spondylectomy for lumbar spinal tumors","authors":"Satoshi Kato MD, PhD ,&nbsp;Yuki Kurokawa PT, PhD ,&nbsp;Noriaki Yokogawa MD, PhD ,&nbsp;Takaki Shimizu MD, PhD ,&nbsp;Hideki Murakami MD, PhD ,&nbsp;Satoru Demura MD, PhD","doi":"10.1016/j.spinee.2025.08.338","DOIUrl":"10.1016/j.spinee.2025.08.338","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Total en bloc spondylectomy (TES) for lumbar tumors significantly impacts lower extremity motor function because of surgical stress on the lumbar nerve roots and psoas muscles.</div></div><div><h3>PURPOSE</h3><div>The aim of this study was to assess the strength of the major lower extremity muscles and walking function following lumbar TES using prospectively collected data and identify functional differences based on the levels of the resected vertebrae.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective study with prospectively collected data.</div></div><div><h3>PATIENT SAMPLE</h3><div>Data were collected from 34 patients who underwent single-level TES for lumbar spinal tumors at our institution between January 2010 and December 2021.</div></div><div><h3>OUTCOME MEASURES</h3><div>Lower extremity motor function and walking ability were evaluated pre- and postsurgery. Lower extremity motor function was analyzed using Manual Muscle Testing of the iliopsoas, quadriceps femoris, and tibialis anterior muscles at baseline and 1, 3, and 6 months postsurgery. The Spinal Cord Independent Measure indoor mobility was used to evaluate ambulation status at baseline and 1, 3, 6, and 12 months postsurgery.</div></div><div><h3>METHODS</h3><div>In lumbar TES at our institution, L1 and L2 nerve roots were often transected while L3–L5 nerve roots were preserved. Dissection of the segmental vessels and detachment of the diaphragmatic crura via an anterior approach were often employed before posterior TES for L1–L3 lesions. Vertebral body resection and cage insertion via an anterior approach were performed following posterior element resection and instrumentation for L4 and L5 lesions.</div></div><div><h3>RESULTS</h3><div>The incidence of postoperative lower extremity muscle weakness was 75% in the TES group at L1 and 100% at L2 or below. Quadriceps muscle weakness was most pronounced in patients who underwent L4-TES, involving wide dissection of the L3 and L4 nerve roots. Tibialis anterior muscle weakness was most severe in patients who underwent L5-TES with wide dissection of the L4 and 5 nerve roots. At 12 months postsurgery, walking ability normalized in all patients except some who underwent L4-TES or L5-TES.</div></div><div><h3>CONCLUSIONS</h3><div>Postoperative lower extremity muscle weakness was severe in patients undergoing TES involving the middle or lower lumbar spine. Patients who underwent L5-TES were more likely to experience residual gait disturbances.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 571-577"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘P172. Rising use of plastics multilayered closure in posterior spinal fusion for adolescent idiopathic scoliosis without clear improvement in wound outcomes’ [The Spine Journal 25/11S (2022) S155]","authors":"Anthony E. Seddio MD ,&nbsp;Sahir Jabbouri MD ,&nbsp;Gwyneth C. Maloy BA ,&nbsp;Jonathan N. Grauer MD ,&nbsp;Dominick A. Tuason MD","doi":"10.1016/j.spinee.2025.11.004","DOIUrl":"10.1016/j.spinee.2025.11.004","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Page 642"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior vs posterior approaches in the management of multilevel degenerative cervical myelopathy: a systematic review and meta-analysis","authors":"Omar Kouli MSc ,&nbsp;Lana Al-Nusair MBBS ,&nbsp;Ashish Basnet MBBS ,&nbsp;Radek Kaiser PhD ,&nbsp;Michael Fehlings MD, PhD ,&nbsp;Martin Wilby PhD ,&nbsp;Nisaharan Srikandarajah PhD","doi":"10.1016/j.spinee.2025.08.336","DOIUrl":"10.1016/j.spinee.2025.08.336","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Degenerative cervical myelopathy (DCM) is the commonest cause of spinal cord dysfunction. The optimal surgical approach for multilevel DCM (MDCM) remains debated.</div></div><div><h3>PURPOSE</h3><div>To assess functional, patient-reported, and surgical-related outcomes of anterior and posterior surgical approaches for MDCM.</div></div><div><h3>STUDY DESIGN</h3><div>Systematic review and meta-analysis.</div></div><div><h3>OUTCOME MEASURES</h3><div>Primary outcomes included modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), pain visual analogue scale (VAS), SF-36, and EQ-5D at ≥1-year. Secondary outcomes included length of stay, C5 palsy, reoperation and intraoperative bleeding.</div></div><div><h3>METHODS</h3><div>Following the PRISMA guidelines, MEDLINE, Web of Science, and Cochrane databases (inception to November 2024) were accessed to search for studies comparing anterior and posterior approaches in adult patients with MDCM spanning ≥2 levels, including cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). Meta-extraction was performed independently by multiple reviewers using Covidence. Data were pooled by a random-effects model, with effect sizes reported as mean differences (MDs) and odds ratios (ORs). Mixed-effects meta-regression accounted for baseline variability. Subgroup analyses examined CSM vs OPLL and follow-up duration (1 vs ≥2 years).</div></div><div><h3>RESULTS</h3><div>At final follow-up, the anterior approach demonstrated significantly better mJOA (MD 0.42, 95% CI, 0.20 to 0.64), NDI (MD -1.29, -2.41 to -0.17) and VAS (MD -0.60, -1.04 to -0.17), though did not reach minimal clinically important differences (MCIDs). Quality-of-life measures were comparable. Subgroup analysis further supported anterior surgery across CSM and OPLL groups. Early advantages of anterior surgery in NDI and VAS diminished until becoming nonsignificant at ≥2 years. Anterior surgery resulted in shorter length of stay (LOS) (MD -1.41 days, -1.91 to -0.90) and lower odds of C5 palsy (OR 0.37, 0.28–0.49).</div></div><div><h3>CONCLUSIONS</h3><div>Both surgical approaches yield comparable long-term outcomes, with anterior surgery demonstrating statistically significant early functional advantages, shorter LOS, and lower odds of C5 palsy. However, these advantages diminish over time, with functional improvements not consistently reaching MCIDs. Given the heterogeneity of DCM, surgical decision-making should be individualized, incorporating patient-specific factors and long-term functional priorities to optimize outcomes.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 558-570"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primer on unilateral biportal endoscopic spine surgery: technical overview for beginners","authors":"Erick R. Kazarian MD ,&nbsp;Jason I. Yang MD ,&nbsp;Gregory S. Kazarian MD ,&nbsp;Yong H. Kim MD","doi":"10.1016/j.spinee.2025.06.003","DOIUrl":"10.1016/j.spinee.2025.06.003","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Unilateral biportal endoscopic (UBE) spine surgery is a minimally invasive technique that offers the benefits of enhanced visualization and reduced tissue disruption compared to traditional open spine surgery.</div></div><div><h3>PURPOSE</h3><div>This review outlines the historical evolution, technical considerations, and adoption challenges of UBE, focusing on its use in lumbar spine procedures.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Technique overview.</div></div><div><h3>METHODS</h3><div>The biportal approach, characterized by separate working and visualization portals, facilitates the minimally invasive benefits of endoscopy while maintaining the tactile feedback of open surgery. Key elements, including portal placement, fluid management, instrumentation, and operative room setup, are discussed.</div></div><div><h3>RESULTS</h3><div>The learning curve for UBE is steep yet manageable, with most surgeons achieving proficiency within 25 to 50 cases through cadaver labs, mentorship, and selective case strategies. Early adoption challenges, such as establishing viewing windows and managing complications, are addressed.</div></div><div><h3>CONCLUSIONS</h3><div>As its indications expand to thoracic and cervical pathologies, UBE promises to enhance patient outcomes by providing effective, minimally invasive surgical options for a broader range of spinal conditions.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 3","pages":"Pages 450-456"},"PeriodicalIF":4.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}